On the Game: Women and Sex Work

INTRODUCTION: PUBLIC WOMEN

… out of the confusion a consensus is emerging that public and private are not (and never have been) ‘conceptual absolutes’, but a minefield of ‘huge rhetorical potential’. Despite their instability and mutability, public and private are concepts which also have had powerful material and experiential consequences in terms of formal institutions, organizational forms, financial systems, familial and kinship patterns, as well as language. In short, they have become a basic part of the way our whole social and psychic worlds are ordered, but an order that is constantly shifting, being made and remade (Davidoff 1995: 228)

The struggle for personhood on the part of sex workers illuminates widespread fictions about normal or proper behaviour. If you work with sex, how do you manage sex outside the money economy; how do you make significant relationships? Sex workers I met considered that they had both a public and a private aspect, just like everyone else. They agreed that they worked with sex and therefore had a public status, like all other workers, but refuted the idea that they were selling or, indeed, giving away a part of themselves that should not be traded in the marketplace. They opposed conventional prejudice suggesting that they were merely ‘public women’. Branded in law, stigmatised for confounding distinctions between love and work and pathologised in terms of disease, sex workers negotiate a highly particular status as public women in London today.

Sex, it seems, should not be sold, and prostitution speaks to the transgression of boundaries, where matter is out of place, where the inside is placed outside and the ‘privates’ exposed. The word ‘prostitute’ can be derived from the Latin, ‘to put’ or ‘to stand’ (statuere) ‘in public’ (pro) but, in the UK, ‘common’ generally serves as a synonym for ‘public’, Common women are considered to have offered their bodies ‘commonly’, that is, frequently, for sexual services in return for payment. The term entered the statute book in the Vagrancy Act of 1824 and it is still used to convict sex workers for loitering or soliciting. The offence of being a common prostitute is applied only to women working outdoors, who are more likely to be working class and non-white, and it is the only offence in which previous convictions can be made known in court before sentencing.¹ If the common man embodies decency, the common woman does not: it is only the man on the ‘Clapham omnibus’ who epitomises public reason in the UK.²

The metaphors of ‘public’ and ‘common’ delineate proper behaviour on the part of women, mediated by age, race, class and social position. They draw a line beyond which you cannot trespass without losing at least some of the attributes of a person. With such a weight of meaning, prostitution³ refers rather less often to the sex industry than to widespread idioms that invoke a morality in which sex and money do not mix. I approach sex work as a key phenomenon of industrial capitalism, which takes its own local shape according to specific Christian precepts of heterosexuality and monogamy.

Images of prostitution apply to anything that is wrongly traded, including corruption in church or government, and this discursive history enters into the everyday world of sex work. Workers carry a particular stigma, an individual blemish or ‘attribute that is deeply discrediting’ (Goffman 1974: 13) which reduces the individual ‘from a whole and usual person to a tainted, discounted one’ (1974: 12). Goffman was interested in the social management of a spoilt identity but stigma can also be seen as a relationship between people, located ‘off’ the body; a matter of ‘connected’ rather than individualised ‘body-selves’ (Das 2001). Stigma proves ‘contagious’: other people think that they might catch ‘it’ – in the form of disease, disorder, immorality, disgrace, deformed children, tainted money, emptiness and alienation. Contagion is often envisaged in the form of a miasma, infecting young innocent bystanders (typically schoolgirls) as they traverse a red-light district, but I shall argue that it also threatens to contaminate the activities associated with any individual sex worker’s life outside her job.

In the summer of 1986, I joined the Praed Street Clinic, a large genitourinary medicine clinic at St Mary’s Hospital in west London, attached to a medical school that has been part of Imperial College since 1987, which sees approximately 70,000 patients per year. AIDS was a pressing concern; it had been linked to gay men and to drug users but a new element was introduced in the 1984–85 parliamentary session. Should prostitutes be registered so that they too could be tested and, if necessary, controlled through a mixture of compulsion, persuasion and service provision?⁴ I was not surprised to see prostitutes named as likely partners in the AIDS epidemic, nor, indeed, was I surprised by calls for their regulation since prostitutes were, and are still, required to have compulsory health checks in many parts of the world. But the media coverage did elicit a response. I made a proposal to investigate the issue in London, informed by early prejudices about these so-called risk groups. I wanted to assess whether London sex workers were at risk and whether they (consequently) posed a risk to others, arguing that prejudice was not necessarily the best guide to action.⁵ I began to work on issues of HIV in the clinic where I set up the Praed Street Project, little by little, with a colleague, Helen Ward, then a clinic doctor and subsequently an epidemiologist.

Embarking on my research, I was surprised to hear the Contagious Diseases legislation of the nineteenth century mentioned frequently, generally by way of contrast with subsequent measures through the Venereal Diseases (VD)⁶ Act (1917) intended to control sexually transmitted infections in the UK through more confidential and voluntary means, and in reference to current dilemmas associated with the prevention and treatment of AIDS. These laws were important to the clinic culture I joined. Medical accounts have been able to reiterate the obvious ‘facts’ about STI transmission, STI prevention and prostitution now that sex workers can be seen and easily distinguished from other people.

But, in the nineteenth century, it was not yet clear who these people were. They had to be found: ‘public women’; women on the streets alone in the wrong places at the wrong times; ‘known’ adulterers or single women; casual labourers in town during the slack season of the agricultural cycle; women consorting with sailors and soldiers, drinking, selling beer, food or lodgings. Prostitutes, it can be claimed now, are at increased risk of STI because they have many sexual partners. It seems obvious that they will be important to the further spread of STI because they are linked directly or indirectly with a wide sector of society. The truth of these assumptions seems to be demonstrated through numerous empirical studies in which multipartner sexual activity can be understood independently of the effects of stigma, poverty and gender. This understanding of prostitution, however, is a complex historical construct, closely informed by past ideas about the morality of sexual activity (Day and Ward 1994). The empiricist and positivist style of medical accounts makes this history difficult to discern.

Subsequent legislation of the mid-twentieth century addressed issues of public order and public decency rather than public health. The Sexual Offences and Street Offences Acts of the 1950s also crystallised readings of public and private which have remained in force to the present time. While of less significance to the clinic I had joined, these Acts determined many aspects of everyday life among the sex workers I met.

It has proved difficult even to demarcate the distinction between public and private in terms other than gender, as noted by scholars in a range of disciplines. Historians have explored the increasing exclusion of women from public spheres as these categories solidified gradually during the eighteenth and nineteenth centuries, and they have shown that the increasing differentiation of public and private was tantamount to a new differentiation of the sexes such that a ‘private sphere’ could appear to be separate from the ‘public’ one. A brief reference to debate and action surrounding legislation in the 1860s, 1917 and the 1950s will serve to sketch the major interests and views that interacted to produce ‘public women’. While it is not my intention to review or evaluate the historical record, this background will also indicate my debt to previous scholars, and especially to feminist insights.

Prostitution became the great social evil and venereal diseases were known, in derivation, as the social diseases. In a veritable conjuring trick, prostitution was defined anew and made visible through a wide array of institutional innovations, including the Contagious Diseases Acts (CDAs), a short-lived public health measure from the 1860s to the 1880s, intended to solve the problem of venereal disease. The Acts allowed for the registration of so-called prostitutes in garrison towns and their confinement, if they were deemed infected with syphilis and gonorrhoea. Prostitutes were no longer able to combine sex work with other jobs, and Walkowitz’s study of Plymouth and Southampton shows how their activities became more covert; they were older and worked for longer than previously: ‘as prostitutes became public figures through the registration process, it became increasingly difficult for them to gain respectable employment, and to move in and out of their other social identities’ (Walkowitz 1980: 210).⁷ The CDAs provoked such opposition that they were soon repealed but the definitive marginalisation of prostitutes continued. As Corbin argued of mid-nineteenth-century France, reforms were intended to create a visible difference between prostitutes and other women, and this difference would serve to encourage proper feminine behaviour (Corbin 1990: 51). Such reforms progressively separated sex workers from their communities and shaped the patterns of sex work that are found today (Walkowitz 1980).⁸

In public, prostitutes could no longer work visibly with other people who provided them with trade, provisions or lodgings, but in private many probably had separate ‘respectable’ identities under different names in other parts of the country with people who did not know about their work. Insofar as a prostitute is wholly equated with her work, her private life becomes invisible, even though it might be very similar in practice to other women’s private lives. The ideology of ‘public women’ is part and parcel of a wider gender ideology and class hierarchy that requires analysis.

By the end of the nineteenth century, there were half a million voluntary female ‘charity workers’ in Britain engaged in philanthropy and at least 20,000 salaried women travelling to work as civil servants and teachers; they shopped and visited galleries, libraries and theatres (Walkowitz 1994: 53).⁹ They complained about male ‘pests’ and wanted the streets made safe for respectable women. Yet, by this time, the terms were set:

… ‘public woman’ was used interchangeably with the terms prostitute, streetwalker and actress; they all implied that the public world excluded respectable women. The ‘public’ was reserved for men and those women who ‘immorally’ serviced them; only the male flâneur had the right to gaze upon the city and the ‘public’ women therein. (Bland 1995: 118; see also Wolff 1985)

Prostitution was generally deemed essential to society because men needed sex and therefore conformed to different standards of behaviour than women, some of whom would have to provide sex and thereby protect the chastity of other women.¹⁰ Thus, illicit sex was licit for men while it attracted criminal sanctions for women (Thomas 1959). However, unless the sequestration of prostitutes actually prevented further transmission of disease and cured the patient – and difficulties even at the level of diagnosis were extensively recognised – many doctors were unwilling to advocate restrictions on personal liberty. By the twentieth century, it was felt generally that the compulsory treatment of prostitutes had failed and a process of self-conscious reflection made much of the benefits of voluntary, anonymous and confidential clinical attention. Official medical histories consider the Venereal Diseases legislation (1917) to have promoted a rational health care system which successfully limited STD through most of the twentieth century and provided the gold standard for care world-wide. Treatment was associated with accessible and appropriate clinics as well as early medical interventions to detect and treat disease. In addition to the ‘lessons of history’ from local UK experiences, which had promoted this new approach, contrasts were drawn with other countries where venereology had not become a separate speciality and where public clinics were not supported effectively.¹¹

That AIDS itself was a newly recognised infectious disease in the 1980s seemed to heighten historical consciousness (Berridge 1992: 327). Many commentators noted parallels in the fear of contagion and the stigma attached to victims of AIDS, syphilis and other infections (for example, Brandt 1988) but, in the clinic, STI control was aligned with ‘triumphalist’ histories where the 1917 legislation was represented as a victory for human rights.

While these public health measures were important in the clinic, other public order and public decency laws were just as critical to sex workers themselves. In particular, a pair of Acts from the 1950s continue to influence the organisation of sex work today, identifying prostitutes first as victims, in need of rescue or protection (1956 Sexual Offences Act), and then as a nuisance to be restricted within acceptable bounds of public order and decency (1959 Street Offences Act). The first Act recognises prostitution as a form of work while the second approaches it as a form of private sexuality, adopting implicitly the position of the customer.

The 1956 legislation prohibited collaboration in sex work on the grounds that victims had to be protected from potential abuse by managers. Prostitution was thereby individualised and disconnected from the infrastructure that made most forms of work possible. The 1959 legislation presented prostitution as a form of ‘vice’, which was licit if it remained suitably hidden from view. The offence of being a ‘common prostitute’ was preserved, even though it proved difficult to legislate what counted as loitering and soliciting ‘in public’ (see Sion 1977: 83). Public places came to include what normally appeared to be private, such as doorways and cars, and the 1964 Act on licensing prohibited the serving of liquor to ‘common prostitutes’, thus excluding sex workers from other places open to the public. In the ‘Wolfenden Report’ (1957),¹² the dominant sense was of visibility rather than payment, work or employment relations: public meant visible. Commentators have suggested that it became more difficult to work occasionally and independently (Wilson 1977, cited in Bland et al. 1979: 108–09; see also Hall et al. 1978), and, as Walkowitz (1980) argued with reference to the 1860s and 1870s, women probably became more, rather than less, dependent on third parties and management.

In contrast to the relatively liberal position taken on homosexuality and subsequently on other personal matters, such as suicide, abortion and divorce, even ‘private’ prostitution attracted severe sanctions because the term could be applied to a person as well as an activity. On the one hand, prostitution is defined as either ‘public’ or ‘private’; only the latter is sanctioned insofar as it is conducted invisibly off the streets and ideally behind closed doors. On the other hand, prostitutes are ‘public’ or ‘common’ women whether or not they are working, engaging in immoral sexual activity, sitting at home, mothering, hiring a video or performing any other activity that is normally, for non-sex workers, considered no business of the criminal justice system.

This criminal justice approach, known as abolitionism, is distinguished broadly from regulation and prohibition. Under prohibition, prostitution as such is a criminal offence, for example, in much of the USA. Regulation is of two very different kinds: licensing or registration (as in Greece and nineteenth-century Britain) contrasts with attempts to decriminalise sex work so that it is controlled by the same laws that apply to other businesses. Preliminary moves to such ‘normalisation’ have been made in countries such as the Netherlands, New Zealand and parts of Australia.¹³ In practice, these broad types of state control can look remarkably similar on the ground in the context of combined toleration and repression through a range of state agencies. Prostitution policy as a whole also needs to be interpreted in the context of the overall size of the sex industry, gender policies, welfare provisions and so forth (Day and Ward 2004c).

Legislation from the 1950s in the UK provides a clear example of the contradictions and peculiarities of the language of public and private that is applied to sex workers today. In permitting prostitution only ‘in private’, a double standard was upheld that allowed men to purchase services ‘privately’ in a domain that, for women, constituted ‘public’ work. This legislation encourages discretion in women and, as far as sex workers are concerned, clear limits to state intervention allow them in principle to work freely so long as they represent their work as private vice to state officials. Yet, in practice, officials constantly threaten to interfere by interpreting so-called private vice in the terms of traditional concerns about public order, public health or public decency. Moreover, they scrutinise private vice to make sure that it is conducted in a solitary and individualised fashion, thus ensuring that sex work is disconnected from other activities through which women make their living or look after their families.

From the perspective of sex workers, these laws have led to a series of fictions which create distinct relationships with the state. First, work has to look like private sexuality. Second, other forms of work and public life have to be dissociated from prostitution and registered with the state independently. Third, ‘private prostitution’ has to be dissociated from an actual private life, which again has to be registered appropriately with the state in the form of mortgages or benefits in order to prevent this ‘private life’ from being drawn into what sex workers consider a public domain. These three fictions are central to the organisation of this book.

By the mid 1980s, concerns about AIDS had forced sex workers to address the associations between prostitution and disease, and to focus almost exclusively on public health once more. The differences between sex workers and other women were exaggerated again and sex worker politics were increasingly formulated in reaction to HIV. Some have argued that this derailed the civil rights movement (Jenness 1993), others that it strengthened it (Doezema 2004). As in the past, a range of coalitions developed. Feminists continued to criticise the double standard and the gendered meanings of common or public. Sex workers had drawn on these critiques and it was in San Francisco during the later 1970s that Carol Leigh (a.k.a. Scarlot Harlot) proposed that prostitution be considered one among many types of sex work (Leigh 1997, see also her website at <http://bayswan.org>).¹⁴ Organisations and unions were formed to demand recognition of sex work and to change laws and policies. In the UK, the English Collective of Prostitutes, founded in 1975, continues to argue that all women’s work should be paid and recognised, as it has since its inception, disputing distinctions between subordination ‘at home’ as a chaste virgin or mother and subordination outside, as a paid whore.

I had assumed that feminist accounts of public and private would resonate with sex workers themselves because of the ways in which they are branded as public women. But some feminists have disputed the status of sex work, and I found that research participants also struggled to accommodate feminist insights into notions of social inequality ‘at home’. As with medicine and the law, the feminist opposition has included many differences of opinion and strategy, and sex workers have allied themselves with only some struggles for change, particularly those arguing for sexual tolerance and representing gay, lesbian, bisexual and transgender issues. By the middle of the 1990s, other feminists had organised specifically against prostitution which they saw less and less as a form of work and more as a modern form of slavery in which poor, non-white women from the south were sold against their will to agents in the north. Discomfort about sex work has divided feminists into pro-choice and anti-slavery camps today in much the same way as it did during the nineteenth century, and in much the same way that other issues of sexuality and reproduction, such as abortion, divide opinion today.

Sex work activists face a difficult task in advancing the politics of gender through organising for better labour conditions and civil rights. Issues of violence and trafficking today raise questions about oppression, feminism and the role of the state, but rarely work conditions. As Walkowitz notes, however, there has been one significant change: while prostitutes had no public voice in the earlier stories, they became important political agents in the later ones. She quotes Sheila Jeffreys (a prominent radical feminist) disapprovingly, ‘Studying prostitutes to explain prostitution is as useful as examining the motives of factory workers to explain the existence of capitalism’ (Jeffreys, Women Against Violence Against Women Conference Papers, cited in Walkowitz 1994: 238). As Corbin too notes:

The prostitute began to tell her own story (circa 1975), explain her own point of view, and in doing so challenged the notion of sexual privation; the theme of the perspicacity of the prostitute, who had become the unmasker of our society, cropped up in most commentaries. (1990: 363–64)

In these increasingly public voices of sex workers, we continue to find concerns about political interference, whether from doctors, feminists or lawyers, alongside opposition to poor work conditions and the economic situation of women more generally. A sex worker website in 2000 posted the comment, ‘Regarding the SEX Industry: It is a terrible moment when financial hardship forces women into a demeaning situation, The Sex Industry has spared many women from that fate.’

In Chapters 2–5, I describe how women I knew in London at the end of the 1980s created and lived a series of public spheres, intermeshed in many ways but carefully segregated in others. As we shall see, one public realm, the state, was virtually personified in the figure of the criminal justice system while another, public opinion, appeared to cloud ordinary people’s judgement in almost every respect. In the eyes of most sex workers, state systems of control and popular imagery epitomised jointly a hostile, negative ‘public’ that excluded, punished and interfered. Participants in our research rarely elaborated the differences between media images and government measures, or between attitudes of neighbours and court procedures. These two senses of the term ‘public’ are part of the occupation; they gloss the pervasive stigma that colours and partly constitutes sex work. They also contrast with other public spheres, such as a free market economy or places of work, which were less directly connected with the state and consequently identified in more positive terms.

Over time, many women I knew managed to negotiate successfully the variety of peculiar public spaces sanctioned for sex work and many also established other careers and homes. Research participants hid their work. It was the covert nature of the occupation that allowed them to live in private as well as in public. They expended considerable effort and creativity in demarcating various public and private spaces so as to counteract the contagious qualities of stigma, which might travel from one aspect of their person to another and limit or ‘infect’ key relationships.

But, once all these publics had been demarcated carefully, women faced a quandary. I argue in Chapters 6–10 that research participants were then faced with the task of integrating their lives. I had intended to explore the consequences of mixing sex and money at work in my research, but I found that the imagery of public and private was situated within a life trajectory where women had to put their lives back together in order to ‘develop’ and ‘succeed’. Specifically, sex workers are charged not with integration but with reintegration. The Home Office (2004), among other players, wants to stop women working in the sex industry and offers ‘reintegration programmes’ such as Information Technology (IT) schemes. An apparently secular vision of development contrasts what will become a bad past with a better future, just like religious views of redemption or conversion.

In sex work, perhaps more than other ways of making a living, the imagery of work and business is intertwined with views about proper behaviour on the part of workers, wives and mothers, and the necessary boundaries between family life and the public world. Christian, and especially Protestant, histories colour work practices today in the UK and these differ, therefore, from capitalist and sex work cultures elsewhere. I use the term ‘reintegration’ to refer to a general realignment towards majority norms where sex is not found in the workplace but only at home, a process that evokes clearly all those many religious interventions over the longue durée designed to save women who have sinned and redeem them through ‘real’ work and ‘proper’ behaviour. Idioms of reintegration, I suggest, build upon those of integration, which circulate more widely. Standard biographical conventions seem to require that the different parts of a life are first demarcated and then related over time. Therefore, I situate processes of reintegration within a wider discussion of the life course and show how sex work illuminates more general processes.

In Chapter 2, I describe how sex workers contained their work, together with the stigma it attracted in specific bodies, places and activities that were treated as though they were fixed. Processes of segregation and boundary marking, however, led to structural problems, since research participants risked becoming stuck rather than moving on or up in life. In later chapters, I explore how women managed to move between their various bodies by softening, questioning and disregarding the distinctions they had earlier enacted. In the first half of the book, I ask how sex workers differentiated aspects of themselves and subsequently, in the second half of the book, how they connected these parts through visions of development or success in life.

Distinctions between public and private are widely recognised as ideological, even fictional, but they also constitute part of our everyday world. In sex work, the stigma of the occupation promotes a particularly emphatic demarcation of public and private. This segregation ‘freezes’ time, as I discuss initially with problems arising from the circulation of substances. But the boundaries between public and private are softened in response to the difficulties of, say, keeping a pregnancy or earnings, and time then becomes more incremental. I explore how spatial and temporal dimensions of public and private were arranged, ‘distorted’ and re-arranged through various methods of work. Invoking Bakhtin’s use of the term ‘chronotope’ to emphasise that space and time are always co-implicated (Bakhtin 1981),¹⁵ I explore different strategies of sex work.

In the event, I found that the stigma and the secrets of the occupation created traces that also led sex workers to avoid or explicitly deny the values to which they had previously subscribed. True, everyone had public and private aspects but, over time, it began to seem that these anticipated some form of integration according to a telos of development that sex workers came to reject. Of course, some had always repudiated these norms and, in Chapter 9, I show how the apparent deviance of sex work appealed to those who already considered themselves misfits, perhaps because they did not work like other people or because they did not practise the same heterosexuality.

Holland and Lave (2001) argue for fuller histories of the person and suggest that a practice perspective helps avoid an ahistorical, asocial, essentialist approach to identity. They write:

we cannot understand enduring struggles as crucibles for the forging of identities unless our accounts encompass the working creativity of historically produced agents and the interconnected differences among their interests, points of view, and ways of participating in the production of ongoing struggles. (2001: 3)

Attending to what they describe as the innermost, generative, formative aspects of subjects as much as other historical events and processes, I shall contemplate this struggle for personhood against a backdrop of 14 years’ involvement with sex workers, from 1986 to 2000.

Although the language of publics and privates was analysed extensively from the 1960s to the 1980s, it was largely abandoned in the subsequent biographical turn in the social sciences. I hope to bring about some rapprochement between the earlier scholarship and more recent interests in time and narrative by exploring how concepts of public and private remain important organising principles in the ‘biographical turn’, even if they are not explicitly discussed. I ask how sex workers distributed their activities across a series of public domains, both when they were working and when they were not; how they inhabited, avoided and rejected their status as ‘common women’. I explore the many ways in which sex workers made their lives through, and despite, the stigma attached to their occupation, focusing on continuities with other idioms of the person in the UK. It is my contention that the ethnography illuminates widespread fictions or norms of the life course, in which we learn to distribute ourselves across a variety of roles, activities or domains and then gather them into a story or, as the terminology implies, a course, path or project in life. How configurations of time/space come together is as important a question as the assertion that they do, and the particularities of sex work illuminate other views of the person.

Alongside my own research, I collaborated with Helen Ward in three studies that will feature in the following pages. One was a survey or cross-sectional study of 280 women conducted between 1989 and 1991, whom we interviewed and screened in a standard way. This study provides a baseline (Ward et al. 1993), enabling us to make generalisations about issues that were important at the time. We established a cohort from 1986 to 1993, including 354 women whom we interviewed and saw at least twice during the period (Ward et al. 1999). I refer to this study as the initial period of follow-up, for we then conducted a second follow-up study from 1997 to 2000, in which we attempted to contact systematically all those women we had known from 1986 to 1993 in order to produce longer-term data on their work, family and health. During the 1990s, I had continued to do sporadic fieldwork and stayed in contact with some sex workers. Towards the end of the decade, significant changes in the local industry and earlier questions that had plagued me about women’s careers led to our third collaborative project in which we looked at developments both in the industry and in women’s lives. These three studies, a survey of 280 women, an initial seven-year follow-up of 354 women and a subsequent follow-up to the year 2000 of 130 of these women, yield different perspectives on sex work and are therefore distinguished. My account is deeply indebted to the 100 or so women I knew well during the period 1986–2000, albeit for varying lengths of time and in different ways. Approximately 20 of these women will appear again and again in the pages that follow; none of them was representative or typical and I hope that our quantitative material will mitigate the bias introduced through selecting only some detailed histories for presentation.

The intimate associations between my research and clinical and public health practices have led me to construct the first set of empirical chapters (Chapters 2–5) in the manner of a report. Although this part of this book is not located exclusively within clinic walls, my own position coloured research activities elsewhere and I attempt to capture the appropriate tone, reflecting qualities of our relationships that led me to learn more about some issues than others. I explore attitudes to work, the market, the law, medicine, the state and civil society. This report prefaces my presentation of the life course from Chapter 6 onwards, where I engage more closely with individuals I knew well as, by and large, they moved from their late teens or early twenties to middle age and found themselves stuck in sex work, moved on and ‘up’ in life, enjoyed alternative lifestyles ‘on the game’ and juggled two or more shifts at home and at work.

My style of presentation in the earlier chapters is a response to the difficulties of writing about such a heavily stigmatised occupation. Confidentiality and anonymity in fieldwork are always difficult issues and particularly troubling in the context of illegal and covert activities. I have not used pseudonyms for the Praed Street Project and the Jefferiss Wing as my research is widely known in the context of these settings, but I have fictionalised information that might identify research participants.¹⁶ This detached reporting style, however, has its own problems since it rhetorically distances sex workers from other people. In the later chapters, therefore, I engage with everyday realities close up, rather than far away, in order to avoid depersonalising sex workers.

The shift in tone between the two parts of the book reflects my attempt to highlight the material intransigence of a difficult environment alongside the ingenuity and creativity demonstrated by individuals as they negotiated prejudices and oppressive policing. Naming has presented something of a problem as most women used several names, all of which have distinctive connotations of class or nationality. I use numbers in the next chapter, in keeping with the clinic setting, but decided to use names from an arbitrary set in the remaining chapters so as to make cross-referencing and reading easier. These names were chosen because they are short, distinctive and easily remembered; they belong to the UK context but also reflect international links within the sex industry. I present them in alphabetical order so as to make it clear that I am drawing them from an arbitrary set.¹⁷

A PUBLIC CLINIC: NOTES, STAFF AND PATIENTS

I joined the Jefferiss Wing (then Praed Street) Clinic in 1986, where I was given a desk in an office and an honorary contract with the hospital. This gave me access to notes and to patients; implicitly, I slowly learned, it also bound me to clinical protocols and determined the nature of much of the research I conducted inside the clinic and even outside. I knew that sex workers used the clinic, indeed, it was reputedly popular with them and I felt it important to work in a setting where health care and screening were available because I had found that much of the literature on prostitution suffered serious bias, focusing generally on the most visible workers on streets, in red-light districts and in police custody and then generalising to sex work as a whole. I wanted to talk to women who worked across the industry, both ‘indoors’ and ‘outdoors’. I began to attend weekly clinic meetings and subsequently the monthly business meetings to request referrals.

The clinic had a number of distinguishing characteristics associated with the legislation described in the Introduction: potential patients can refer themselves as to emergency services independently of their General Practitioner (GP); records are confidential and patients carry a number which differs from other hospital numbers; there is no prescription charge for treatment, and, of course, these GUM clinics specialise in the treatment of sexually transmitted infections. According to the VD Act of 1917 and later directives, records should remain internal to the clinic but they can be required by criminal law, High Court subpoena and, in theory, the ‘public interest’. In addition, staff may suggest that they are integrated with main hospital services for complex medical problems. There is widespread confusion over the legal status of clinic records and, given the stigma of infection, patients commonly imposed additional protection through the use of phantom names and addresses. They also used local addresses at times, to ease referral within the National Health Service (NHS).

GUM clinics are charged with preventing as well as treating infections. Primary prevention requires larger-scale and longer-term auditing on a population level than the clinical treatment of individuals who present themselves for care, and the two roles can be difficult to combine. The intractable problems facing GUM clinics today, which have to marry STI care and prevention, identify unmet needs in relation to service delivery, approach diseases of sexuality in relation to what is now called sexual health as well as documenting all this work and assessing its effectiveness, can also make clinicians virtually irrelevant to the more statistical disciplines of epidemiology, public health and what tends to be called simply audit. Porter and Porter argued that the decision to monitor disease anonymously in the 1917 VD Act, rather than through the compulsory notification of individual cases, had little to do with civil liberties, which have been emphasised so much in the ‘lessons of history’ approach towards HIV infection. They considered that empirical evidence from a public health perspective was not of any great significance either. Instead, they suggested, it was the status difference between consultants and clinicians as compared to public health officials that mattered:

The argument that eventually won the day in the British context for the forces of non-notification had less to